与患者的访谈和焦点小组,FLS临床医生,全科医生确定了与骨骼健康和骨质疏松症药物的临床和共同决策相关的挑战。研究结果将为开发多组分iFraP干预措施提供信息,以解决已确定的培训需求和实施障碍,以促进关于骨质疏松症药物的SDM。
目的:iFraP(改善骨折预防治疗的摄取)研究旨在开发多组分干预措施,包括骨质疏松症决策支持工具(DST),支持关于骨质疏松症药物的共享决策(SDM)。要通知iFraP干预发展,这项定性研究探索了与骨骼健康和骨质疏松症药物交流相关的当前实践,预期的障碍,和促进者,骨质疏松症DST,和感知的培训需求。
方法:参加FLS咨询的患者(n=8),FLS临床医生(n=9),和全科医生(全科医生;n=7)被有目的地抽样参加焦点小组和/或电话访谈.数据被转录,感应编码,然后映射到理论域框架(TDF)作为演绎框架,系统地识别可能的障碍,和促进者,实现DST。
结果:归纳代码被演绎地映射到12个TDF域。FLS临床医生被认为具有专业知识(知识)。然而,临床医生将临床决策和风险沟通方面描述为困难(认知技能)。患者反映了对药物的决策不确定性(决策过程)。关于当前实践和拟议DST的讨论表明了促进SDM的机会,如果确定的培训需求得到满足。确定了潜在的个人和系统级别的实施障碍,例如FLS配置的差异以及向远程咨询(环境上下文和资源)的转变。
结论:对当前实践的理解揭示了未满足的培训需求,表明单独使用DST不太可能产生向SDM的持续转变。调查结果将影响iFraP干预发展,以解决未满足的需求。
Interviews and focus groups with patients, FLS clinicians, and GPs identified challenges relating to clinical and shared decision-making about bone health and osteoporosis medicines. Findings will inform the development of the multicomponent iFraP intervention to address identified training needs and barriers to implementation to facilitate SDM about osteoporosis medicines.
OBJECTIVE: The iFraP (improving uptake of Fracture Prevention treatments)
study aimed to develop a multicomponent intervention, including an osteoporosis decision support tool (DST), to support shared decision-making (SDM) about osteoporosis medicines. To inform iFraP intervention development, this qualitative
study explored current practice in relation to communication about bone health and osteoporosis medicines, anticipated barriers to, and facilitators of, an osteoporosis DST, and perceived training needs.
METHODS: Patients attending an FLS consultation (n = 8), FLS clinicians (n = 9), and general practitioners (GPs; n = 7) were purposively sampled to participate in a focus group and/or telephone interview. Data were transcribed, inductively coded, and then mapped to the Theoretical Domains Framework (TDF) as a deductive framework to systematically identify possible barriers to, and facilitators of, implementing a DST.
RESULTS: Inductive codes were deductively mapped to 12 TDF domains. FLS clinicians were perceived to have specialist expertise (knowledge). However, clinicians described aspects of clinical decision-making and risk communication as difficult (cognitive skills). Patients reflected on decisional uncertainty about medicines (decision processes). Discussions about current practice and the proposed DST indicated opportunities to facilitate SDM, if identified training needs are met. Potential individual and system-level barriers to implementation were identified, such as differences in FLS configuration and a move to remote consulting (environmental context and resources).
CONCLUSIONS: Understanding of current practice revealed unmet training needs, indicating that using a DST in isolation would be unlikely to produce a sustained shift to SDM. Findings will shape iFraP intervention development to address unmet needs.